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DANE COUNTY ZONING PERMIT DCPZP 2017-00086 Page 1 of 2 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> GARY M SCHLUTER (608) 246-2785 GERALD ANDLER (608) 252-8887 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 4947 FELLAND RD 534 MAPLE AVE #2 <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53718 MADISON, WI 53704 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> geraldwandrle@ameritech.net <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0810-352-8220-6 TOWN OF BURKE <br /> 35 NW NE <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 4947 FELLAND RD <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 1 CSM 03312 <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture 10 Description:house addition 434- Residential Addition <br /> District <br /> Category ® Residential ❑ Commercial ❑ Agricultural SEWER SANITARY PERMIT NO. <br /> Private <br /> ❑ Other: <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> C-Town Road YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ca NO ❑ YES ® NO <br /> HEIGHT(In Feet) BASEMENT 1st FLOOR TOTAL SQUARE FEET <br /> 256 <br /> 9 Sq.Ft. SC Sq.Ft. <br /> PROJECT COST <br /> NO OF STORIES 2nd FLOOR 3rd FLOOR $30,000.00 <br /> 1 Sq.Ft. Sq.Ft. PERMIT FEE <br /> $69.20 <br /> I, the undersigned, am the owner of the property or an authorized agent acting on behalf of the owner of <br /> the property. I certify that the work to be performed, as part of this zoning permit, will be constructed as <br /> noted on the submitted plans and comply with the applicable zoning ordinances. I understand that failure <br /> to comply with any provision or condition of this permit renders this zoning permit null and void and <br /> subject to enforcement action. <br /> I acknowledge that I am responsible for complying with State and Federal laws concerning construction <br /> near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be <br /> difficult to identify. Failure to comply may result in removal or modification of construction that violates <br /> the law or other penalties or costs. For more information, visit the Department of Natural Resources web <br /> page at www.dnr.state.wi.us or contact the Department of Natural Resources Service Center. <br /> I hereby consent to the entry on the permitted premises 19y Dane County zoning inspectors for the <br /> purposes of determining compliance with the zoning ordinances. <br /> Owner&Agent hereby agree to comply with all Dane County SIGNA ',6- • -r/A. - •t DATE: <br /> Ordinances.Any unauthorized change from the information or <br /> plans submitted will invalidate the permit. 0, �� 4 J ' <br /> Ii AA/1,Y <br /> OFFICE USE ONLY (form versijn 03.01.00) <br /> SURVEY REQUIRED? DATE ISSUED INIT •lr 1st INSPECTION DATE INITIALS <br /> 03/16/2017 • SSA1 <br /> ❑ YES ® NO DATE RE IEWEP INITIALS 2nd INSPECTION DATE INITIALS <br /> Initials: I./ ki/ ' - L f zr <br />